Gov. Newsom wants to overhaul California’s mental health care system. Here’s a plan for that

When Gov. Gavin Newsom focused this year’s State of the State address on California’s looming crisis of homelessness, he vowed to improve the state’s mental health programs.

“We will be laser-focused on getting the mentally ill out of tents and into treatment,” the governor said.

The governor is right that mental health programs need a reboot, and fortunately there is a roadmap for how to do it: two reports from California’s independent government watchdog, the Little Hoover Commission, lay out proposed reforms.

In 2015 and 2016, the commission examined the programs funded by Proposition 63, the “millionaire’s tax” that voters approved in 2004 to expand mental health services. 

Newsom criticized these programs for too often failing to get resources to those who are in need, and he called for greater flexibility and accountability in how counties spend the money raised through the tax. He issued a bold threat to local officials who now control the programs: 

“My message is this, spend your mental health dollars by June 30, or we’ll make sure they get spent for you.”

The detailed proposals contained in our Little Hoover reports would go a long way toward achieving Newsom’s goals.

What did we recommend?

• First, more transparency. 

We found that while the tax had generated billions of dollars in revenue for mental health programs, the state could not fully identify how the money had been spent, or who it had helped. There have been some improvements since our reports were issued, but the state needs to stay focused on collecting reliable data about Proposition 63 programs and telling the story of who has been helped. Key indicators such as suicide and homelessness rates should be used to determine whether the state is successfully helping those with mental illness to live independently and successfully.

• Second, more accountability. 

The law allows counties to withhold 33% of their Proposition 63 funding as a “prudent reserve.” But Gov. Newsom reported that right now 40 of the state’s 58 counties are sitting on extra money, rather than spending it. That echoes our concern that for too many years, the state could not show it was keeping its promise to the voters who approved the tax. As a result, we said, the state should broaden its authority to impose sanctions and withhold funding when it identified deficiencies in a county’s spending plan.

• Third, increased public engagement. 

As we said in 2015, the state needs to “create more meaningful ways for the public to guide and participate in spending decisions” about mental health programs.

• And last: copy what works. 

We recommended that the state encourage replication of successful programs by sharing model systems and ideas beyond county borders.

Gov. Newsom deserves credit for tackling this tough issue. Our Little Hoover Commission reports can help Newsom and the Legislature plot the path ahead, and we’ll be sharing copies of those reports with policymakers. 

As our state’s elected leaders work to solve one of our most pressing problems—the tragic way in which mental illness contributes to homelessness—we believe our work can be an important part of ensuring that treatment is available to every Californian who needs it. 

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Pedro Nava is the chair of the Little Hoover Commission, a bipartisan oversight agency that makes reform recommendations to the governor and Legislature,  littlehoover@lhc.ca.gov. He wrote this commentary for CalMatters.